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Atrial fibrillation is the most common arrhythmia after cardiac surgery. The incidence is up to 40% after coronary artery bypass grafting and even higher after valve replacement and combined valve and bypass surgery. The pathophysiology is not clear, but an exaggerated inflammatory response is a possible causecause.
A randomised double blind placebo controlled multicentre trial enrolled nearly 250 people without a history of atrial fibrillation or a flutter who were undergoing heart surgery. The intervention group received 100 mg of intravenous hydrocortisone in the evening of the day of the operation, and then every eight hours for the next three days. In addition, all patients received oral metoprolol.
In the three and a half days after surgery, atrial fibrillation was recorded in nearly half of the patients in the placebo group and in less than a third of those given corticosteroids (adjusted hazard ratio 0.54, 95% CI 0.35 to 0.83; number needed to treat 5.6). Rates of complications were comparable between groups.
The authors also pooled their results with those of two previous similar trials. The three trials together studied more than 600 people and gave a risk ratio of 0.67 (95% CI 0.54 to 0.84).